Consensus statement on screening, diagnosis, classification and treatment of endemic (Balkan) nephropathy

Abstract

Currently used diagnostic criteria in different endemic (Balkan) nephropathy (EN) centers involve different combinations of parameters, various cut-off values and many of them are not in agreement with proposed international guidelines. Leaders of EN centers began to address these problems at scientific meetings, and this paper is the outgrowth of those discussions. The main aim is to provide recommendations for clinical work on current knowledge and expertise. This document is developed for use by general physicians, nephrologists, urologist, public health experts and epidemiologist, and it is hoped that it will be adopted by responsible institutions in countries harboring EN. National medical providers should cover costs of screening and diagnostic procedures and treatment of EN patients with or without upper urothelial cancers.

Keywords: aristolochic acid nephropathy; consensus statement; diagnostic criteria; endemic nephropathy; upper urothelial cancer.

FIGURE 1:

Diagnostic algorithm for endemic (Balkan) nephropathy. α-1M, alpha1 microglobulin (mg/L); UAC, albumin (mg/L); α-1MCR, alpha1 microglobulin/urinary creatinine (mg/g), ACR, albumin to creatinine ratio. Orange arrow denotes optional; decision may be made by nephrologist.

FIGURE 2:

Diagnostic algorithm for patients with upper urothelial cancer and the risk for endemic (Balkan) nephropathy. For abbreviations, see legend in Figure 1. Histopathology of renal cortex (distant from tumor) obtained during surgery of patient with UUC may be sufficient for making definitive diagnosis of EN. The proposed algorithm will help to establish the degree of renal impairment, and it is also recommended for patients with bladder cancer. If the diagnosis of EN is established, further examination of upper urinary tract is warranted. As hematuria is frequently present in patients with urothelial cancer, dipstick is unreliable.